Diagnosis-Related Group (DRG) Manager

The DRG Manager leads the planning, coordination, and execution of DRG audit activities, ensuring teams meet client SLAs and operational goals. This role oversees inventory, aging, risks, and day-to-day performance, while collaborating cross-functionally to support program success.

The role directly manages a team of auditors responsible for MS-DRG and APR-DRG reviews, ensuring accurate coding and reimbursement outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.

Salary Range: $100,000 – $120,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

A brief coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

Responsibilities

• Support the execution and ongoing improvement of DRG audit programs, including readmissions and place of service reviews
• Partner with cross-functional teams (product, analytics, technology, operations) to support implementation of audit solutions
• Oversee day-to-day audit operations, ensuring alignment with SLAs, quality expectations, and productivity goals
• Manage inventory, workflow distribution, aging, and throughput to ensure timely completion of audits
• Provide direct supervision to auditors, including coaching, feedback, and performance management
• Ensure adherence to productivity, quality, and turnaround standards
• Monitor regulatory and payer guideline updates, ensuring audits remain compliant and current
• Support performance management processes, including one-on-ones, training, and development planning
• Identify operational gaps and contribute to process improvement initiatives
• Escalate and help resolve client or operational issues as needed
• Support reporting activities, including productivity, quality, and inventory metrics
• Assist with program implementations and operational initiatives

Qualifications

• CCS, RHIT, RHIA preferred
• 5–8 years of experience with MS-DRG and APR-DRG, including strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines
• Prior experience leading teams or acting in a supervisory capacity
• Strong understanding of DRG reimbursement methodologies
• Knowledge of Medicare, Medicaid, and commercial payer guidelines
• Experience working in audit or payment integrity operations
• Strong analytical skills with ability to identify trends and support decision-making
• Effective communication and interpersonal skills
• Proficiency in Microsoft Office and audit/reporting systems

Key Skills & Attributes:

• Ability to manage audit workflows and team performance to meet operational targets
• Strong understanding of quality, productivity, and audit accuracy standards
• Ability to analyze data and identify trends and improvement opportunities
• Effective collaboration across clinical, operational, and technical teams
• Ability to support process improvements and workflow enhancements
• Strong organizational and time management skills
• Ability to build relationships and maintain positive team and client interactions

What We Offer:

✨ A fast-paced, innovative environment with a team of industry-leading experts

✨ Hands-on experience with top-tier clients in the healthcare industry

✨ A strong culture of collaboration, support, and inclusivity

✨ Competitive benefits package, including healthcare, vision, dental, and 401(k) options

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. 

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.

EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.